CHICAGO – Office-based surgery is safe when performed by dermatologists, according to a study of 10 years of complication and death reports from Florida and 6 years of data from Alabama.
Dermatologic surgeons could use the findings to combat any legislative attempts to curtail office procedures, including liposuction, Dr. Brett Coldiron said.
Dr. Brett Coldiron
Some plastic surgeons, for example, are trying to restrict what types of office surgeries dermatologists can legally perform, said Dr. Coldiron, a private practice dermatologic surgeon and member of the dermatology faculty at the University of Cincinnati.
The study indicates procedures performed by plastic surgeons actually carry a greater risk for adverse events and death, compared with dermatologic surgeries, Dr. Coldiron said.
A plastic surgeon contacted for comment, Dr. Michael McGuire, said the comparison is unfair given the differing complexity of surgeries done by the two specialties. "It’s a total misrepresentation of the statistics. There is no question that the incidence and even the deaths are smaller with dermatology than with any other specialty."
"Comparing an abdominoplasty – a tummy tuck – with a skin cancer excision or even a small volume of liposuction is ridiculous. To compare that with doing tummy tucks, and 4- or 5-hour facelifts, or major breast reconstructive surgery, all of which are done in outpatient surgery centers, is apples and oranges. They are totally different procedures," said Dr. McGuire, who is in private practice in Santa Monica, Calif., and director of The American Board of Plastic Surgeons.
The prospectively collected data show "that any claims by plastic surgeons or anesthesiologists that dermatologists are doing unsafe things and injuring patients in the office is unfounded," Dr. Coldiron said. "And ... if they are going to make such claims, they should have some data to back them up."
Both Alabama and Florida require notification when an outpatient experiences serious injury, transfer to a hospital, or death related to surgery. These mandatory reports are part of public record in the state of Florida, for example.
Dr. Coldiron found 46 deaths and 263 complications that required hospital transfers in Florida. Cosmetic (nonmedically necessary) procedures were associated with 57% of these deaths and almost 50% of such transfers in the state. Liposuction or liposuction with another cosmetic procedure (abdominoplasty, for example) resulted in death for 10 patients and hospital transfer in another 34 cases.
The majority of cosmetic procedure deaths (67%) and hospital transfers (74%) in Florida were performed under general anesthesia, said Dr. Coldiron.
This is relevant because some physicians who perform liposuction under general anesthesia are trying to restrict liposuction under local or tumescent anesthesia, he said. "There have been legislative attempts to prohibit this. The state of New York recently passed a law restricting liposuction in offices, under local anesthesia to 500 cc, which paradoxically will increase the number of injuries and deaths."
"When you try to restrict the use of local anesthesia or tumescent anesthesia ... you will force more people into using general anesthesia, which has more complications. Hospital transfers or deaths with the use of local anesthesia are incredibly rare," Dr. Coldiron said in an interview. "In fact, I’m only aware of a couple that occurred after anaphylactic reactions."
"They [dermatologists] like to blame the general anesthesia," Dr. McGuire said. "It’s not the general anesthesia that is the difference; it’s the magnitude of the surgery. Clearly there are going to be more risks and complications with major surgery compared to minor surgery under any kind of anesthesia." Plastic surgeons in Florida reported the most adverse events (45% of the total), compared with 1.3% reported by dermatologists.
A meeting attendee questioned a direct comparison between specialties, citing the higher complexity of cases typically performed by plastic surgeons. "Yes, the plastic surgeons do more big, multiple procedures and have more problems," Dr. Coldiron replied. "That does not give them the right to try and restrict our practices under the guise of patient safety at the level of the state medical boards and legislatures that is preposterous."
The current study is in press, and represents an update of Dr. Coldiron’s previously reported 7-year Florida data (Dermatol. Surg. 2008;34:285-91).
Additional information is available on the website for Dr. Coldiron's practice, including real adverse event incident reports.
Alabama reports support and validate the Florida data, Dr. Coldiron said. There were three deaths and 52 adverse events that required an office-to-hospital transfer in Alabama. Cosmetic procedures were associated with zero deaths and 42% of hospital transfers during the 6 years. The Alabama medical board provided Dr. Coldiron with the data upon request.